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Abstract: Physical exercise is proposed as a highly effective means of treating and preventing the main causes of morbidity and mortality most of which are associated with aging in industrialized countries. Low physical fitness is an important risk factor for cardiovascular and all-causes morbidity and mortality; indeed, it is even a predictor of these problems. When properly measured, the assessment of physical fitness can be a highly valuable indicator of health and life expectancy and, therefore, should be performed routinely in the clinical setting. Individually adapted training programs could be prescribed based on fitness assessment results and an adequate knowledge of patient lifestyle and daily physical activity. Such training programs would allow people to develop their maximum physical potential, improve their physical and mental health, and attenuate the negative consequences of aging. Keywords: aging, physical fitness, physical activity, health
Introduction
The increase in life expectancy and the reduction in the birth rate are major problems faced by industrialized societies. From a health and social point of view, it is more important that research be orientated towards promoting healthier aging than simply finding better ways to treat aging-related illnesses (Abbott 2004). A highly effective form of promoting healthy aging is the practice of physical exercise with the aim of improving physical fitness. Several studies have clearly shown that physical fitness is an important predictor of both cardiovascular and all-cause mortality. In addition it is a good predictor of being able to live an independent life at old age (Myers et al 2002; Myers 2003; Gulati et al 2003; Kurl et al 2003; Piepoli et al 2004). This work discusses the importance of physical fitness as an index of health, the relationship between physical fitness and aging, how to assess physical fitness in a clinical setting, and the prescription of exercise for improving physical fitness and, consequently, positively influencing the aging process.
Correspondence: Manuel J CastilloGarzn Departamento de Fisiologa Mdica, Facultad de Medicina, Universidad de Granada, 18071 Granada, Spain Tel +34 958 243540 Fax +34 958 249015 Email mcgarzon@ugr.es
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Body composition
Muscular strength
Flexibility
Figure 1 Components of physical fitness associated with aspects of good health and disease prevention, or both.
performance of physical activity or physical exercise or both. Thus, being physically fit implies that the response of these functions and structures will be adequate. A person cannot be more physically fit than that allowed by the function or structure in poorest condition in their body. Anti-aging-related physical fitness includes those components of physical fitness associated more with aspects of good health and/or disease prevention (Figure 1).
2003). It has even been reported that, while pharmacological anti-depression treatment may induce a more rapid initial response, the efficacy of exercise is the same at 16 weeks (Blumenthal et al 1999) (Table 1).
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in metabolic equivalents (METs) (1 MET is the energy expenditure at rest [~3.5 ml/kg/min]). Thus, if a subject has a VO2max of 42 ml/kg/min, he also has an energy expenditure of 12 METS (ie, he is able to increase his resting energy expenditure 12-fold). A number of important prospective studies have shown that the VO2max is the most important predictor of all-cause mortality, and in particular of cardiovascular death. This is true both for healthy persons and those with cardiovascular disease (Carnethon et al 2003), and for both men (Laukkanen et al 2001; Balady 2002; Kurl et al 2003) and women (Gulati et al 2003; Mora et al 2003) of different ages (Myers et al 2002). An almost linear reduction in mortality is seen as the aerobic capacity increases (Myers et al 2002; Mora et al 2003) (Figures 2, 3). For each increase of 1 MET there is a 12% increase in the life expectancy of men (Myers et al 2002) and a 17% increase in women (Gulati et al 2003; Figures 2 and 3, respectively). This is even more evident if cardiovascular mortality is considered alone, and is true for both men (Carnethon et al 2003; Kurl et al 2003) and women (Gulati et al 2003; Mora et al 2003). An inverse relationship has also been found between aerobic capacity and mortality due to cancer a relationship quite independent of age, alcohol intake, the suffering of diabetes mellitus, and even the use of tobacco (Lee and Blair 2002; Evenson et al 2003; Lee et al 2003; Sawada, Muto, et al 2003). Similarly, it has been shown that the VO2max is an important determinant of insulin sensitivity (Seibaek et al 2003; Sawada, Lee, et al 2003); low VO2max levels are associated with metabolic syndrome (abdominal obesity, glucose intolerance, type II diabetes, hypertension, hyperlipidemia and insulin
3 2
1 0 <5
Low
6
Medium
>8
High
METS
Cardiorespiratory fitness
Figure 3 The maximum aerobic capacity is a powerful predictor of all-cause mortality in women (drawn from data contained in Mora et al 2003 ). The figure shows percentage survival as a function of the aerobic capacity (VO2max expressed in METs). Survival is worse in subjects with lower aerobic capacity. Abbreviations: METs, metabolic equivalents; VO2max, maximum oxygen consumption.
resistance) (Bertoli et al 2003; Lakka et al 2003). A good aerobic capacity reduces the neuronal losses associated with aging (Colcombe et al 2003) and protects against cognitive dysfunction (Barnes et al 2003).
<5
10
11
12
>13 METS
Very low
Low
Medium
High
Very high
Cardiorespiratory fitness
Figure 2 The maximum aerobic capacity is a powerful predictor of all-cause mortality in men (drawn from data contained in Myers et al 2002). The figure shows percentage survival as a function of the aerobic capacity (VO2max expressed in METs). Survival is worse in subjects with lower aerobic capacity. Abbreviations: METs, metabolic equivalents; VO2max, maximum oxygen consumption.
Castillo-Garzn et al
Male Female
40 30 20 10 0 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 age (years)
y = -0.227x + 36.017 r = 0.64
Figure 4 Deterioration of hand grip strength with age (cross-sectional study performed on healthy Spanish people [222 men, and 208 women]).
of the physical qualities associated with physical fitness (Laukkanen et al 1992; EC and UKK 1998). These tests should always include the assessment of aerobic capacity, the muscular strength of the upper and lower body, flexibility, and psychokinetic capacities (ie, agility, coordination, balance, visual and auditory reaction times). Table 2 shows the tests most commonly used in clinical practice for the evaluation of physical fitness orientated towards anti-aging therapy.
and efficiency of cardiovascular and metabolic systems. They also help in the control and reduction of body fat. The results of aerobic exercise, eg, walking, are very positive, especially for cardiovascular health. These improvements are independent of race, sex, age, and body mass index (Manson et al 2002). A program of regular aerobic exercise of three to six months duration can improve aerobic capacity by 15%30% (ACSM 1998). Undertaking weekly aerobic exercise lasting 6090 minutes leads to significant reductions in the systolic and diastolic blood pressure in hypertensive men and women. No further improvement is seen if this time is extended (IshikawaTakata et al 2003). There is substantial evidence that aerobic training exerts a favorable influence on the blood lipid and lipoprotein profiles at any age (Pate et al 1995; Fletcher et al 1996). The dose-response relationships between the amount of exercise and favorable blood lipid and lipoproteins changes suggest that exercise can exert a positive influence on blood lipids even at low training volumes, although the effects may not be observed until certain exercise thresholds are met (ACSM 1998). Another important benefit of aerobic exercise is the reduction it causes in insulin resistance (Sato et al 2003). Similar results have been obtained in the treatment of diabetes and metabolic syndrome (Watkins et al 2003; Swartz et al 2003). Finally, aerobic exercise performed for 30 min at least three times per week has been shown to have a potent therapeutic effect on certain mental illnesses such as depression and anxiety and panic syndromes (Babyak et al 2000; Paluska and Schwenk 2000).
Table 2 Some of the most used clinical tests for assessing physical fitness with a view to anti-aging therapy
Physical fitness-related capacities Aerobic capacity Tests 2 km walking (UKK test) Bruce test Power work capacity 170 Hand grip strength Arm flexions Bent arm hang Squat jump Counter movement jump Abalakov Curl up test Seat and reach Standing reaching up Plate tapping Ladder test Flamingo
Strength (kg)
Muscular strength (trunk strength) Flexibility Agility Eye-hand coordination Eye-toe coordination Static balance test (right and left leg)
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FUNCTIONAL CAPACITY
Load period
FUNCTIONAL CAPACITY
WEAR
RECOVERY ADAPTATION
Figure 5 Left: Physical exercise (Load period) implies organic wear that reduces functional capacity (Wear). With rest and correct nutrition, lost functional capacity can be recovered (Recovery). This is followed by a period of overcompensation to exertion (Adaptation). This forms the theoretical basis of training. Right: The timing of training (A, B o C) influences functional capacity either improving it (A), causing it to worsen (B) or having no effect (C) (Delgado et al 2004).
A training frequency of 35 days a week is recommended. It is preferable to avoid single, hard bouts of exercise once a week (Ruiz et al 2004). Training intensity should be at some 55%/65%90% of the maximum heart rate, or of the maximum reserve heart rate (maximum HR rest HR) (ACSM 1998). Lower intensity values, eg, 40% 49% of the maximum reserve heart rate and 55%64% of the maximum heart rate, are recommended for unfit individuals. The duration of training should be 3060 min of continuous or intermittent (10 min or longer bouts accumulated over the day) aerobic activity. The duration is dependent on the intensity of the activity; thus, lowerintensity activity should be conducted over 30 min or more, while individuals training at higher intensity levels should do so for 20 min or more. Because of the importance of total fitness, that this is more readily attained with exercise sessions of longer duration, and given the potential hazards and adherence problems associated with high-intensity activity, moderate-intensity activity of longer duration is recommended for adults not training for athletic competition (ACSM 1998). Any activity that uses the large muscle groups (eg, walking, hiking, running, jogging, cycling, cross-country skiing, aerobic dancing, rope skipping, rowing, stair climbing, swimming, skating, endurance game activities, etc.), that can be maintained continuously and is rhythmical and aerobic in nature, is recommendable. Brisk walking is preferable for older people since this has a low impact on the joints, although recreational sports are also recommended. These guidelines for healthy adults are those published by the American College of Sports Medicine (ACSM 1998).
FUNCTIONAL CAPACITY
FUNCTIONAL CAPACITY
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100 90
80
*
Bench Press (kg)
75 70 65 60 55 50 45 40
80 70 60 50 40 30
35 30
50 48 46
*
Biceps curls (kg)
20 18 16 14 12 10 8 6 4
44 42 40 38 36 34 32 30
Pre
Post
Pre
Post
Figure 6 Effects of a resistance training program (3 days/week) for 3 months on maximum strength in older people. Note: *p0.05. Bars are mean standard error of mean.
exercise for all major muscle groups (1015 repetitions for older or more frail persons) (Armstrong 1984). It is recommended that novice lifters train with loads of 60%70% of a one repetition maximum (RM) for 8 12 repetitions. Advanced individuals should use loading ranges of 70%90% of the RM in a periodic fashion to maximize muscular strength (ACSM 2002). For progression in those individuals training at a specific RM load (eg, 812 repetitions), it is recommended that a 2% 10% increase be applied on the basis of muscle group size and involvement (ie, greater load increases may be used for large muscle groups and for multiple-joint exercises) when the individual can perform at his/her current intensity for one or two repetitions more than the desired number in two consecutive training sessions (ACSM 2002). Recently, it has been reported that power training is more effective than strength training for maintaining bone mineral density in postmenopausal women (von Stengel et al 2005). This suggests that fast movements provide greater benefit than slow movements.
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Studies of resistance training in older subjects Age (y) Gender Training program 6080 75 69 6787 6080 6574 M M +W W W W M 8 weeks 12 months 12 weeks 12 months 8 weeks 16 weeks
Conclusion
Aging is a physiological process that can be influenced for the better (delaying it) or worse (accelerating it). The most recent scientific evidence shows that regularly and appropriately practiced physical exercise, in order to improve physical fitness, is currently the best way to delay or even prevent the consequences of aging. Such exercise always brings benefits, irrespective of the age, sex, health, or the physical condition of the person who undertakes it. In contrast, a lack of exercise clearly accelerates aging and its consequences, including ones physical appearance. Among people of the same age and genetic background, those who remain physically active, who eat correctly, and who avoid risk factors, look younger and maintain a more youthful nature. Recent research has shown that a persons degree of physical fitness is an excellent predictor of life expectancy and quality of life. Improving ones physical fitness increases life expectancy and prevents age-associated diseases. To be effective, the aerobic capacity needs to be increased, along with strength and joint mobility. In conclusion, potentiating physical fitness is undoubtedly the best medicine available today for combating the inexorable process of aging.
References
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